Comparison of microinsulated needle radiofrequency and carbon dioxide laser ablation for the treatment of syringoma

Syringoma is a benign adnexal tumor originating from the intradermal eccrine ducts and predominantly occurs in women at puberty or later in life. We present a case of a 30‐year‐old woman with a 2‐year history of syringoma on her neck and axillar region. She was treated with two devices in a split manner. The right‐sided lesions of the neck were treated with one session of 10,600‐nm carbon dioxide (CO₂) laser ablation. The left‐sided lesions were treated with microinsulated needle radiofrequency (RF) three times. After treatment, the lesions treated with CO₂ showed hypertrophic scar formation, but the other side lesions treated with microinsulated needle RF showed a marked reduction in the size and number of lesions, without any adverse effects such as scarring and hyperpigmentation related to epidermal damage. The treatment of syringoma with microinsulated needle RF, which is insulated at the point of epidermal contact, results in good cosmetic outcomes. Syringoma, microinsulated needle RF, CO₂ laser.     

Two cases of multiple eccrine spiradenoma with linear or localized formation

We report two rare cases of recurrent, multiple eccrine spiradenoma. Both cases presented with extensive lesions comprised of multiple red papules of various sizes and a soft blue-red nodule. The first case was a 30-year-old woman. Her lesions followed a linear arrangement on her chin, and extended down the right side of the neck with spontaneous pain. The second case was a 57-year-old woman with tumors in a localized group on the left occipital region without pain. A search of the literature revealed only 15 reported cases of linear/zosteriform/nevoid multiple eccrine spiradenoma. Both cases were treated by surgical excision. Most of the red papules displayed typical histological features including two cell types: large clear cells with low-density cytoplasm; and small dark cells with high-density cytoplasm. The large soft tumors exhibited a variable histological appearance. In the first case, the cystic tumors displayed an homogeneous structure comprised of eosinophilic material. In the second case, the cystic tumors included abundant interstitial tissue.     

Using oral tetracycline and topical betamethasone valerate to treat acrodermatitis continua of hallopeau

Acrodermatitis continua of Hallopeau (ACH) is a rare type of localized pustular psoriasis. We report the case of a 65-year-old alcoholic woman who had severe inflammatory ACH for 10 years. Initial therapy with sulfasalazine was unsuccessful. The patient was then treated with oral tetracycline and topical betamethasone valerate with occlusive dressing. Her condition improved dramatically after one week.     

获得性皮肤松弛症

报告1例获得性皮肤松弛症。患者女,17岁。面颈、双腋窝及股部皮肤松弛2年。皮肤科检查:面颈、双腋窝及股部皮肤明显松弛,皱纹密集,皮沟加深,无弹性。左颈部皮损组织病理示:表皮厚度大致正常,网篮状角化,真皮浅层血管周围少量淋巴细胞浸润。弹性纤维染色示:真皮浅层弹性纤维数量明显减少、形态异常。诊断:获得性皮肤松弛症。     

Diffuse plane xanthoma in an otherwise healthy woman

We report a case of diffuse plane xanthoma in a 40-year-old otherwise healthy woman. Her disease began 18 years ago as xanthelasma and progressed to involve large areas of her face, neck and trunk. No associated diseases were detected on repeated laboratory testing.     

A clinical study on the usefulness of autologous plasma filler in the treatment of nasolabial fold wrinkles

Background: Recently, the efficacy of autologous plasma filler for the reduction of facial wrinkles has been demonstrated. Objective: The aim of our study is to validate the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. Material and methods: Twenty Korean patients with moderate-to-severe nasolabial fold wrinkles were enrolled. The patients were treated with one session of autologous plasma filler. The wrinkle improvement effects were evaluated at 1-week, 4-week, 8-week, and 12-week after the treatment. Three assessment methods were applied. First, two independent dermatologists assessed cosmetic results using a 5-point wrinkle assessment scale. Second, global aesthetic improvement score was used for assessment of the final cosmetic results. Third, patient satisfaction was surveyed. Also, the adverse effects associated to treatment were observed. Results: Mean age of the patients was 44.5 years. The average 5-point wrinkle assessment scale score was significantly improved at 1, 4, 8, and 12 weeks after treatment, comparing to before treatment (p < 0.01). The patients’ average global aesthetic improvement score also indicated better cosmetic outcomes. Conclusion: The clinical improvement with sufficient patients’ satisfaction and no significant adverse events demonstrated that novel autologous plasma filler could be considered as efficient and safety treatment option for nasolabial fold wrinkles.     

Unusual wrinkle formation after temporary skin fixation followed by UVB irradiation in hairless mouse skin

Abstract Generally, many wrinkles form on the human face, and temporary wrinkles eventually become permanent. We evaluated the effects of temporary skin fixation on wrinkle formation after UVB irradiation using the back skin of hairless mice. In the group treated with UVB irradiation immediately after production using cyanoacrylate resin of an artificial groove parallel to the midline, wrinkles formed parallel to the midline, an uncommon direction for wrinkle formation in this mouse model. These wrinkles did not disappear even when the skin was stretched. No such changes were observed in the group in which only the temporary groove alone was produced without UVB irradiation. In 3-D surface parameter analysis, all roughness parameters in the group treated with UVB irradiation immediately after production of an artificial groove were significantly increased relative to the age-matched control group. In contrast, no differences were observed between the group in which only the temporary groove alone was produced without UVB irradiation and age-matched controls. The results of this study suggest that both a temporary groove in the skin and UVB irradiation are necessary for wrinkle formation in the back skin of hairless mice.     

Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six‐year experience with 333 patients

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty‐three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.     

Electro-optical synergy (ELOS™) technology for nonablative skin rejuvenation: a preliminary prospective study

BACKGROUND AND OBJECTIVES: In this preliminary prospective study, we evaluated the efficacy and safety of nonablative wrinkle treatment using combined radiofrequency (RF) and optical energy (Polaris). The dual energy technology of Polaris, called ELOS, which stands for electro-optical synergy, uses synchronous pulses of bipolar RF current and pulsed visible light (diode laser) delivered in the same pulse. MATERIALS AND METHODS: Twenty-four subjects with periorbital and perioral wrinkles received six treatments at 4-week intervals with the Polaris WR (Syneron, Inc., Israel, 900 nm, max. RF energy 100 J/cm(3), max. laser energy 50 J/cm(2)). Each treatment consisted of two passes over the treatment area using pulsed optical and RF parameters that were determined by the patient's skin phenotype and distribution of target chromophores. The follow-up period was 3 months after the last treatment. RESULTS: Independent scoring of blinded photographs showed a wrinkle score improvement of at least 1 (0 = no improvement, 1 = medium, 2 = good, 3 = excellent improvement) 3 months after the last of six treatment sessions. There was no difference between periorbital and perioral wrinkle reduction. Fifty-eight per cent (14/24) of the subjects reported a notable wrinkle reduction; 16% noted mild to moderate oedema and erythema lasting for no more than 1 day. Scarring or pigmentary changes were not detected. The average pain score was 0.6 (0 = no pain, 5 = intolerable pain). CONCLUSION: Multiple treatments with the Polaris WR produced objective and subjective reduction of periorbital and perioral wrinkles. The occurrence of side-effects and pain was very low. The clinical effect may be caused by matrix coagulation of the deep dermis by the RF and selective thermolysis of blood vessels with the 900 nm diode laser.     

The efficacy of glycolic acid for treating wrinkles: analysis using newly developed facial imaging systems equipped with fluorescent illumination

The clinical characteristics of photodamaged skin, such as coarse and fine wrinkling, can not be quantitatively evaluated from ordinary photographic records. The purpose of this study was to assess the efficacy of glycolic acid (GA) peeling on facial wrinkling, using computer assisted image analysis. This was accomplished with reproducible imaging techniques, which allowed precise repositioning of the subject's face in front of the camera. Two parameters, the change in wrinkle number and the change in wrinkle length were assessed. Although the clinical improvement of wrinkles correlated with both parameters, wrinkle length more precisely reflected the degree of clinical wrinkles, because the wrinkle number appeared to increase as some shallow wrinkles divided into multiple smaller wrinkles during their improvement. Comparison of responses by different age groups showed that the reduction of total wrinkle length was observed in the order of: 50s>30s and 40s>60s>over 70>under 30. The lack of response by subjects over 70 might be due to the nature of their wrinkles being mainly coarse wrinkles rather than fine ones. We next compared the effect of GA by concentration (35, 50 or 70%), but found no significant differences. As the concentration of GA used for treatment was determined by each subject's erythema reaction, our present result suggests that erythema elicited by GA correlates with improvement of wrinkles and that these two phenomena can be induced by a common pathway of GA treatment. This quantitative analysis clearly shows the efficacy and limitation of GA treatment of wrinkles, and might help to disclose the precise mechanisms of GA effects on the skin structure and function.     

Evaluation of a combined laser-radio frequency device (Polaris WR) for the nonablative treatment of facial wrinkles.

Nonablative wrinkle reduction or skin tightening is desired by individuals who, ideally, hope to have the skin improvement associated with chemical or laser ablative techniques but without the undesirable recovery process. Electro-optical synergy (ELOS) technology that combines radio frequency (RF) and diode laser energy (900 nm) was used to treat 15 patients in this IRB sanctioned study. Energy settings were based on the depth of wrinkles (the greater the depth and concentration of wrinkles, the higher the RF setting) and ranged from 50-100 J/cm2 RF and 15 J/cm2 for the optical, laser component. Patients received three full-face treatments, and results were evaluated by comparison of standardized photographs and patient questionnaire given prior to each treatment and one month after the third treatment. The primary investigator and three other "blinded" physicians evaluated these photographs using Fitzpatrick's wrinkle classification to assess the improvement, if any, between the initial and final visit. Eight patients completed the study. Explanation for the exclusion of the remaining six patients were: one decided to have surgery, two felt the treatment was too painful, and three moved out of the area. Following treatment, all patients had mild swelling (resolved <48 hours) and skin hyperemia (resolved <24 hours). Results observed one month after the last treatment in eight patients demonstrated an average of 25% reduction in skin wrinkles (range 14%-32%). There were no adverse side effects. The major concern of the patients was the discomfort associated with the treatment. As part of an FDA investigation to assess efficacy, long-term follow-up was not a part of this study protocol.     

Hyaluronic acid microneedle patch for the improvement of crow's feet wrinkles

Hyaluronic acid (HA) has an immediate volumizing effect, due to its strong water‐binding potential, and stimulates fibroblasts, causing collagen synthesis, with short‐ and long‐term effects on wrinkle improvement. We investigated the efficacy and safety of HA microneedle patches for crow's feet wrinkles. Using a randomized spilt‐face design, we compared microneedle patches with a topical application containing the same active ingredients. We enrolled 34 Korean female subjects with mild to moderate crow's feet wrinkles. The wrinkle on each side of the subject's face was randomly assigned to a HA microneedle patch or HA essence application twice a week for 8 weeks. Efficacy was evaluated at weeks 2, 4, and 8. Skin wrinkles were measured as average roughness using replica and PRIMOS. Skin elasticity was assessed using a cutometer. Two independent blinded dermatologists evaluated the changes after treatment using the global visual wrinkle assessment score. Subjects assessed wrinkles using the subject global assessment score. Skin wrinkles were significantly reduced and skin elasticity significantly increased in both groups, although improvement was greater in the patch group at week 8 after treatment. In the primary and cumulative skin irritation tests, the HA microneedle patch did not induce any skin irritation. The HA microneedle patch is more effective than the HA essence for wrinkle improvement and is a safe and convenient without skin irritation.     

The Fabi-Bolton chest wrinkle scale: a pilot validation study

Up until now, no objective scale has existed to evaluate chest wrinkles and assess the efficacy of treatment. This study was designed to validate a new photonumeric wrinkle assessment scale using standardized photographic methodology to obtain reference photographs. Multiple photographs from 28 volunteer subjects with varying degrees of chest wrinkles were evaluated by a study team of two independent physicians. Photographs of 16 subjects representing the full spectrum of chest wrinkle severity were selected and classified using the Fabi–Bolton (F–B) 5‐point wrinkle scale (1 = wrinkles absent; 2 = shallow but visible wrinkles; 3 = moderately deep wrinkles; 4 = deep wrinkles, with well‐defined edges; 5 = wrinkles very deep with redundant folds). One representative photograph was chosen by study team consensus for each of the five scale points. A second, independent group of evaluators rated the randomly arranged photographs using the F–B wrinkle scale. The numeric results were then tabulated and compared. The F–B wrinkle scale provided a reproducible and effective method for assessing chest wrinkles with very little interrater variability. The F–B wrinkle scale is a reliable tool for the classification of chest wrinkles and evaluation of therapeutic and cosmetic interventions.     

Multipoint and multilevel injection technique of botulinum toxin A in facial aesthetics

Botulinum toxin represents one of the most frequently requested cosmetic procedures. We treated 223 patients with facial wrinkles using a new technique of injection of botulinum toxin A (BTA) called multipoint and multilevel injection technique (MMIT). The aim of MMIT was to relax the muscle and not paralyze it. Patient satisfaction was evaluated by Facial Line Treatment Satisfaction Questionnaire (FTSQ). Treatment with botulinum toxin determined a good response in all patients. Facial rhytids were completely resolved in case of young skin and well reduced in case of aged skin, leaving a natural aspect both in static and dynamic wrinkles. Patient mean overall satisfaction evaluated with FTSQ was 6.4 ± 1.1. In our experience, the use of botulin toxin by MMIT consents a better calibration of action with a soft and natural result. This can be achieved by distributing the BTA dose through various injection points for each area (“multipoint injections”). Furthermore, injections can be performed at different levels (“multilevel injections”). The level of injections regulates the potency of effect on the muscle: if the level is deep (intramuscular), the effect will be strong while if it is medium or superficial (subcutaneous and intradermal), the effect will be soft. This consents a fine calibration of action on muscle activity with a personal aesthetic result.     

Effect of a preparation containing a fucose-rich polysaccharide on periorbital wrinkles of human voluntaries

BACKGROUND: Skin aging is accompanied by wrinkle formation. At some sites, as the periorbital skin, this is a relatively early phenomenon, variable from one woman to the other and even between the right and left eye. PURPOSE: We tested the effect of a preparation with fucose-rich oligo- and polysaccharide (FROP-3) on periorbital wrinkles (crow's feet) on a team of voluntaries. METHOD: The efficiency of a preparation containing as active principle a fucose-rich polysaccharide in a base-cream for the treatment of temporal periorbital wrinkles on 20 voluntary women was tested as follows: the women applied the cream twice a day for 4 weeks. Negative replicas were taken on the periorbital skin before and after 4 weeks of application of the cream. The results were evaluated by semi-automated morphometry on the plastic replicas and expressed as the 'wrinkle-factor' obtained by multiplying total wrinkle length in millimeters by the average wrinkle width. RESULTS: After 4 weeks of treatment, there was a significant improvement of the periorbital wrinkles for the majority of the voluntary team who tested the cream. On the 29 periocular wrinkles examined 65% showed an improvement at the end of the treatment. In two cases, the improvement was 100% on one eye (disappearance of the crow's feet) and of 75% and 79% on the other eye. On six eyes, there was no significant change after the end of the treatment, and on four eyes a worsening was observed. The age-dependent modifications showed that improvement was independent of age and was the result of individual skin reactions to the cream. The occurrence and the severity of crow's feet is highly individual, and differs from one side of the face to the other for the same person. These strong individual variations explain the highly variable results, not only from one woman to the other but also comparing one side of the face to the other for the same person. CONCLUSION: Under the effect of 4 weeks of treatment with the FROP-3-containing cream, most of the voluntaries had their periorbital wrinkles attenuated and some women showed a total regression of crow's feet on one of their eyes.     

Two Cases of Aquagenic Wrinkling of the Palms in Korean Healthy Women: Easily Overlooked Disease

Aquagenic wrinkling of the palms (AWP) is a rare condition, which is characterized by appearance of whitish papules and plaques and an excessive wrinkling and swelling of the palmar skin after exposure to water. Herein, we report two cases of AWP. A 17-year-old woman presented prickling focal various sized whitish papules, plaques with wrinkles on both palms after water contact for 6 months ago. Histologic findings were consistent with AWP. A 26-year-old woman presented asymptomatic multiple various sized whitish papules, plaques with wrinkles on both palms after water contact for 1 year ago. Both patients underwent a cystic fibrosis transmembrane conduct receptor test but were negative and improved without any treatment.     

Evaluation of a combined laser‐radio frequency device (Polaris WR) for the nonablative treatment of facial wrinkles

Nonablative wrinkle reduction or skin tightening is desired by individuals who, ideally, hope to have the skin improvement associated with chemical or laser ablative techniques but without the undesirable recovery process. Electro‐optical synergy (ELOS) technology that combines radio frequency (RF) and diode laser energy (900?nm) was used to treat 15 patients in this IRB sanctioned study. Energy settings were based on the depth of wrinkles (the greater the depth and concentration of wrinkles, the higher the RF setting) and ranged from 50–100?J/cm² RF and 15?J/cm² for the optical, laser component. Patients received three full‐face treatments, and results were evaluated by comparison of standardized photographs and patient questionnaire given prior to each treatment and one month after the third treatment. The primary investigator and three other “blinded” physicians evaluated these photographs using Fitzpatrick's wrinkle classification to assess the improvement, if any, between the initial and final visit. Eight patients completed the study. Explanation for the exclusion of the remaining six patients were: one decided to have surgery, two felt the treatment was too painful, and three moved out of the area. Following treatment, all patients had mild swelling (resolved <48?hours) and skin hyperemia (resolved <24?hours). Results observed one month after the last treatment in eight patients demonstrated an average of 25% reduction in skin wrinkles (range 14%–32%). There were no adverse side effects. The major concern of the patients was the discomfort associated with the treatment. As part of an FDA investigation to assess efficacy, long‐term follow‐up was not a part of this study protocol.     

Type I immediate hypersensitivity reaction to cyanocobalamin but not hydroxycobalamin

We report a case of a 42-year-old woman with a background of autoimmune polyglandular syndrome, who developed a type I immediate hypersensitivity reaction to intramuscular cyanocobalamin. Intradermal testing showed a positive reaction to cyanocobalamin. The patient was subsequently treated with intramuscular hydroxycobalamin after negative intradermal testing to this alternative B₁₂ compound. A review of previously described cases of hypersensitivity to either compound provides a rationale for the management of this rare but serious side-effect.     

Odontogenic sinus tract to the neck skin: a case report

We describe a 22-year-old woman with neck skin sinus tract that developed as a consequence of dental infection. The patient was treated twice in an inappropriate way with recurrence of the sinus tract. We opted for an extraction of the tooth. This case illustrates the need for cooperative diagnostic referrals between physicians and dentists.     

Improvement in skin wrinkles from the use of photostable retinyl retinoate: a randomized controlled trial

Background Photoaged skin can be treated with retinoids, which are natural and synthetic vitamin A derivatives. However, these are photounstable and can cause skin irritation, which is a major limitation in their use in general cosmetics. Retinyl retinoate, which is an ester of all‐trans retinoic acid (RA) and all‐trans retinol, has reduced toxicity due to blocking of the carboxyl end group of RA and higher skin regeneration activity than retinol. Objectives To assess the efficacy of a photostable retinyl retinoate in treating women over 30 years old with periorbital wrinkles. Methods We conducted two clinical studies with a total of 46 Korean women with periorbital wrinkles, who were not pregnant, nursing or undergoing any concurrent therapy. In the first clinical study, the efficacy of retinyl retinoate was compared with placebo. Twenty‐four patients completed a 12‐week trial of 0·06% retinyl retinoate applied twice daily to one side of the face and a placebo applied to the other side. In the second clinical study, the efficacy of retinyl retinoate was compared with retinol. Twenty‐two patients completed an 8‐week trial of 0·06% retinyl retinoate applied twice daily to one side of the face and 0·075% retinol applied to the other side. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and visiometer analysis (Skin‐Visiometer SV 600; Courage & Khazaka, Cologne, Germany) every 4 weeks. The standard wrinkle and roughness parameters used in assessing skin by visiometer were calculated and statistically analysed. Results The retinyl retinoate‐treated wrinkles improved compared with wrinkles treated with placebo or retinol, as assessed by both the investigators and the subjects. Also, skin replica analysis indicated significant improvements in retinyl retinoate‐treated skin in both studies, especially in average roughness. Conclusions Retinyl retinoate applied twice daily was significantly more effective than a placebo or retinol in treating periorbital wrinkles. Importantly, no severe side‐effects were observed.